COPD Flashcards

1
Q

What is bronchitis?

A

Inflammation of the lining of the bronchiole which narrows the airway

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2
Q

What is emphysema?

A

When the smaller alveoli collapse into larger air sacs

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3
Q

Is COPD fully reversible?

A

No

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4
Q

What are the main respiratory symptoms of COPD?

A

Breathlessness, cough and recurrent chest infection

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5
Q

What is the main cause of COPD?

A

Smoking

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6
Q

What non-respiratory systems are also associated with COPD?

A

Loss of muscle mass, weight loss, cardiac disease and depression/anxiety

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7
Q

What factors would make you suspect that a patient might have a COPD?

A

Age - over 35yrs, current or former smokers, chronic cough, breathlessness, sputum production, recurrent ‘winter’ bronchitis and wheeze or chest tightness

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8
Q

If a patient has nocturnal symptoms and conditions such as eczema or allergic rhinitis, is it more likely to be COPD or asthma?

A

Asthma

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9
Q

On examination what sort of signs might you see if the patient has a COPD?

A

Reduced chest expansion, prolonged expiration/wheeze, hyper inflated chest and possibly signs of respiratory failure

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10
Q

What are the signs of respiratory failure?

A

Tachypneoa (rapid breathing), Cyanosis (blue skin or lips), use of accessory muscles, pursed lip breathing and peripheral oedema

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11
Q

Why is spirometry used in when a COPD is suspected?

A

It can show an air obstruction which leads to a diagnosis and also determines the severity

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12
Q

Why is an ECG sometimes done in those with COPD?

A

To look for any cardiac compromise and heart failure

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13
Q

What non-pharmacological methods are used for the COPD management?

A

Smoking cessation, vaccinations, pulmonary rehabilitation, nutritional assessment and psychological support

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14
Q

What are the benefits of pharmacological management of COPD?

A

Relief of symptoms, prevention of exacerbations and improved quality of life

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15
Q

What different types of inhaled therapy are people with COPD given?

A

Short acting bronchodilators - SABA and SAMA
Long acting bronchodilators - LAMA or LABA
High dose inhaled corticosteroids (ICS) and LABA

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16
Q

At what point would a patient with COPD be put on long term oxygen?

A

If the arterial partial pressure drops below 7.3kPa or is between 7.3 - 8 kPa but the patient has nocturnal hypoxia, polycythaemia, pulmonary hypertension or peripheral oedema etc.

17
Q

What symptoms would suggest an exacerbation of the COPD?

A

Increasing breathlessness, cough, increase in volume/purulence of sputum, wheeze and chest tightness

18
Q

How would an acute exacerbation of COPD (AECOPD) be managed?

A
  • Short acting bronchodilators (nebulisers if need be)
  • Steroids - prednisolone
  • Antibiotics - if signs of infection
  • Hospital admission if unwell - tachypneoa, low oxygen sats (less than 90%), hypotension etc.
19
Q

What investigations might be done if a patient is admitted to hospital with an acute exacerbation of their COPD?

A
  • Full blood count –Biochemistry
  • Glucose
  • Theophylline conc.
  • ABGs
  • ECG
  • Blood cultures
  • Sputum microscopy, culture and sensitivity
20
Q

Besides smoking, what causes COPD?

A
  • Chronic asthma,
  • Passive smoking
  • Maternal smoking
  • Air pollution
  • Occupation
21
Q

What is meant by 1 pack year?

A

1 pack of cigarettes every day for a year

22
Q

What would you expect to see on a chest radiograph of a patient with emphysema?

A

Hyperinflated lung fields (>10 ribs posteriorly), flattened diaphragms, lucent lung fields and bullae

23
Q

Name the investigations used to diagnose COPD

A
  • Spirometry
  • CXR
  • ECG
  • FBC
  • BMI
  • AIAT (if under fifty years)
24
Q

Name the complications of COPD

A
  • Acute exacerbation
  • Pneumonia
  • Macro-nutrient deficiency
  • Wasting
  • Muscle Atrophy
  • Polycythemia
  • Pulmonary hypertension
  • Cor pulmonale
  • Depression
  • Pneumothorax
25
How would an acute exacerbation of COPD be managed on the wards?
- Target sats of 88-92% - Nebulised bronchodilators - Corticosteroids - Antibiotics - Assessing for evidence of respiratory failure
26
Name the causes of COPD not attributed to smokin
- Chronic asthma - Passive smoking - Maternal smoking - Air pollution - Occupation
27
What is the function of a1-antitrypsin?
It neutralises enzymes released by neutrophils
28
List the potential differentials for COPD
- Asthma - Lung cancer - Left ventricular failure - Fibrosing alveolitis - Bronchiectasis - Rare: TB and recurrent pulmonary emboli
29
What features on a CXR would suggest COPD
- Hyperinflated lung fields (>10 posterior ribs) - Flattened diaphragms - Lucent lung fields - Bullae
30
What would an FBC show in a patient with COPD?
Secondary polycythaemia
31
What might an ECG show in a patient with COPD?
- Right axis deviation - P pulmonale - T wave inversion V1-4
32
List the clinical features of an acute exacerbation of COPD
- Increased cough and sputum - Increased SOB - Wheeze - Oedema - Confusion - Drowsiness - Cyanosis - Flapping tremor - Pyrexia
33
Which investigations would you order for an acute exacerbation of COPD
- CXR - Blood gases - FBC - U&Es - Sputum culture
34
How can an acute exacerbation of COPD be managed
- Nebulised bronchodilator B2 and anti-muscarinic - O2 - Oral/IV corticosteroid - Antibiotics - Diuretics - IV aminophylline - Respiratory stimulant - NIV